Accuracy of 4-Dimensional Computed Tomography for Localization in Primary Hyperparathyroidism

Eller, Michael; Dave, Atman; Johnson, Craig M.; Fingeret, Abbey L.

doi:10.1016/j.jss.2020.07.055

Cited by 11 publications

(18 citation statements)

References 22 publications

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“…A total of 23 studies investigated PHPT patient populations before initial parathyroid surgery. 8,[10][11][12][13][14][15][16][17][19][20][21][22][23][24][26][27][28][29][30][31][32][33] However, 3 studies reported specifically on patients with PHPT with recurrent/reoperative disease. 9,25,28 Characteristics of parathyroid disease are summarized in eTable 2 in the Supplement.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In subsets of patients with single-gland parathyroid disease (SGD), sensitivity of 4D-CT localization ranged from 58% to 92%, contrasted with 43% to 67% in patients with multigland parathyroid disease (MGD). 10,12,17,23,32,33 DECT & PET/CT Only 5 studies investigated the relatively novel application of DECT and PET/CT for PHPT patients. The mean values for DECT localization were 77.5% accuracy, 87.0% sensitivity, and 88.5% PPV.…”

Section: D-ctmentioning

confidence: 99%

“…For patients with recurrent PHPT requiring reoperation, 4D-CT pooled sensitivity was 81% (95% CI, 64%-98%; I 2 = 93%) in contrast to 53% (95% CI, 35%-71%; I 2 = 81%) for sestamibi-SPECT/CT. The overall quality of the 26 studies was moderate with a median (range) Methodological Index for Nonrandomized Studies score for all included studies of 15.5 (13)(14)(15)(16)(17)(18)(19).…”

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confidence: 99%

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Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Kattar

Migneron

Debakey

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Emerging computed tomographic (CT) imaging techniques for the localization of primary hyperparathyroidism (PHPT) may be superior to the current imaging standard, thus necessitating a critical review and pooling of available evidence.OBJECTIVE Primary hyperparathyroidism requires accurate imaging to guide definitive surgical management. Advanced techniques including 4-dimensional computed tomographic (4D-CT) scan have been investigated over the past decade. We sought to evaluate the efficacy of these emerging imaging techniques through pooled analysis of the existing evidence.DATA SOURCES PubMed, Embase, and Web of Science databases were queried for original English articles without any restrictions on date.STUDY SELECTION We included comparative observational studies but excluded animal studies, case reports, and case series. Overall, 353 abstracts were screened independently by 2 investigators along with a third reviewer to resolve conflicts. A total of 26 full-text articles were included in this review.DATA EXTRACTION AND SYNTHESIS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data was independently extracted by 2 investigators and subsequently pooled into a metaanalysis using a random-effects model. MAIN OUTCOMES AND MEASURESMeasures of imaging diagnostic performance such as sensitivity, specificity, positive predictive value, and negative predictive value were the primary outcomes of interest.RESULTS Overall, of 34 articles screened, 26 met criteria for qualitative synthesis, and 23 of these were appropriate for meta-analysis. Of the 26 studies included, there were 5845 patients, of which 4176 were women (79.2%). The average of mean ages reported in 23 studies was 60.9 years. Meta-analysis in all patients with PHPT revealed pooled sensitivity that was greater with 4D-CT (81%; 95% CI, 77%-84%; I 2 = 88%) compared with the current first-line modality of sestamibi-single-photon emission CT (SPECT/CT) (65%; 95% CI, 59%-70%; I 2 = 93%). For patients with recurrent PHPT requiring reoperation, 4D-CT pooled sensitivity was 81% (95% CI, 64%-98%; I 2 = 93%) in contrast to 53% (95% CI, 35%-71%; I 2 = 81%) for sestamibi-SPECT/CT. The overall quality of the 26 studies was moderate with a median (range) Methodological Index for Nonrandomized Studies score for all included studies of 15.5 (13)(14)(15)(16)(17)(18)(19). CONCLUSIONS AND RELEVANCEThe findings of this systematic review and with meta-analyses of numerous studies from the past decade suggest that the 4D-CT can be more sensitive and specific than sestamibi-SPECT/CT in localizing PHPT. More research is needed to determine the clinical significance of this improvement in localization.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: D-ctmentioning

confidence: 99%

mentioning

confidence: 99%

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Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Kattar

Migneron

Debakey

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…4D-CT and choline PET have recently increased the rate of identification of pathological glands, but their results are also dependent on the size of the lesion. These modalities are likely to become an important part of the work-up and to increase the success rate of treating M-pHP [45,46].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of MILD hyperparathyroidism

Lecourt

Creff

Coudert

et al. 2021

Eur Arch Otorhinolaryngol

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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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“…Among these, 100 duplicate articles as well 92 studies, including 33 not in the field of interest, 8 case reports, 31 abstracts, 15 reviews, one editorial, three congress and meetings, and one without full text were excluded. Among the remaining 46 articles, 16 [11][12][13][20][21][22][23][24][25][26][27][28][29][30][31][32] finally met the inclusion criteria and were subsequently included in our analysis. A flow diagram of eligible literature is shown in Figure 1.…”

Section: Literature Searchmentioning

confidence: 99%

Diagnostic Role of Four-Dimensional Computed Tomography for Preoperative Parathyroid Localization in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis

et al. 2021

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We sought to systematically evaluate diagnostic performance of four-dimensional computed tomography (4D-CT) in the localization of hyperfunctioning parathyroid glands (HPGs) in patients with primary hyperparathyroidism (pHPT). We calculated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratios (DOR) of 4D-CT on a per-lesion level, as well as pooled sensitivity and positive predictive value (PPV) on a per-patient level with 95% confidence intervals (CIs). Additionally, we plotted summary receiver operating characteristic (SROC) curves and evaluated the areas under the curves (AUC). A total of 16 studies were included in the analysis. Their pooled sensitivity, specificity, PLR, NLR, and DOR of 4D-CT on per-lesion level were 75% (95%CI: 66–82%), 85% (95%CI: 50–97%), 4.9 (95%CI: 1.1–21.3), 0.30 (95%CI: 0.19–0.45), and 17 (95%CI: 3–100), respectively, with an AUC of 81% (95%CI: 77–84%). We also observed heterogeneity in sensitivity (I2 = 79%) and specificity (I2 = 94.7%), and obtained a pooled sensitivity of 81% (95%CI: 70–90%) with heterogeneity of 81.9% (p < 0.001) and PPV of 91% (95%CI: 82–98%) with heterogeneity of 80.8% (p < 0.001), based on a per-patient level. Overall, 4D-CT showed moderate sensitivity and specificity for preoperative localization of HPG(s) in patients with pHPT. The diagnostic performance may improve with 4D-CT’s promotion to first-line use on a lesion-based level, further research is needed to confirm the results.

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Accuracy of 4-Dimensional Computed Tomography for Localization in Primary Hyperparathyroidism

Cited by 11 publications

References 22 publications

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism

Surgical management of MILD hyperparathyroidism

Diagnostic Role of Four-Dimensional Computed Tomography for Preoperative Parathyroid Localization in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis

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